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Attenuation of C-Reactive Protein Increases After Exodontia by Tramadol and Ibuprofen
Eman A. El-Sharrawy MBBCh, MSc, MD,
 Ibrahim E. El-Hakim BDS, MDS, PhD, and
 Elham Sameeh BDS, MDS
Article Category: Research Article
Volume/Issue: Volume 53: Issue 3
Online Publication Date: Jan 01, 2006
DOI: 10.2344/0003-3006(2006)53[78:AOCPIA]2.0.CO;2
Page Range: 78 – 82

recent studies have reported that the combined use of tramadol and an NSAID provides effects superior to each drug used separately. 10 11 The purpose of this investigation was to compare the anti-inflammatory effect of tramadol with that of ibuprofen as assessed by changes in C-reactive protein (CRP) concentrations and the efficacy of their combined use after third-molar extraction. METHODS This study was conducted on 45 American Society of Anesthesiologists Class I patients scheduled for the surgical removal of an impacted lower third

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Alex Stamos DDS, MS,
 Melissa Drum DDS, MS,
 Al Reader DDS, MS,
 John Nusstein DDS, MS,
 Sara Fowler DMD, MS, and
 Mike Beck DDS, MA
Article Category: Research Article
Volume/Issue: Volume 66: Issue 4
Online Publication Date: Jan 01, 2019
Page Range: 192 – 201

Systematic and Cochrane reviews have found superior postoperative pain control with combinations of ibuprofen/acetaminophen versus use of either medication alone. 1 – 4 However, these reviews were largely based on third molar extraction models in young adults who have no pain or pre-existing infections. As stated by Moore and Hersh, 5 the efficacies of ibuprofen combined with other nonsteroidal anti-inflammatory drugs differ depending on the model being studied. They further stated that additional research evaluating postoperative pain

Figure 4 ; Percentage of patients taking ibuprofen, ibuprofen/acetaminophen, and opioid. Opioid percentages are presented on top of the ibuprofen and ibuprofen/acetaminophen percentages.
Alex Stamos,
 Melissa Drum,
 Al Reader,
 John Nusstein,
 Sara Fowler, and
 Mike Beck
<bold>Figure 4</bold>
Figure 4

Percentage of patients taking ibuprofen, ibuprofen/acetaminophen, and opioid. Opioid percentages are presented on top of the ibuprofen and ibuprofen/acetaminophen percentages.


Alex Stamos,
 Melissa Drum,
 Al Reader,
 John Nusstein,
 Sara Fowler, and
 Mike Beck
<bold>Figure 2</bold>
Figure 2

Percentages and discomfort ratings of postoperative pain for the ibuprofen and ibuprofen/acetaminophen groups by day. patients requiring opioids were excluded on days 2–4.


Alex Stamos,
 Melissa Drum,
 Al Reader,
 John Nusstein,
 Sara Fowler, and
 Mike Beck
<bold>Figure 3</bold>
Figure 3

Percentages and discomfort ratings of postoperative percussion pain for the ibuprofen and ibuprofen/acetaminophen groups by day. Patients requiring opioids were excluded on days 2–4.


Papimon Chompu-inwai DDS, MS,
 Sophon Simprasert DDS, MS,
 Patchanee Chuveera DDS, MIPH,
 Areerat Nirunsittirat DDS, MS, PhD,
 Thanapat Sastraruji PhD, and
 Tanida Srisuwan DDS, MS, PhD
Article Category: Research Article
Volume/Issue: Volume 65: Issue 3
Online Publication Date: Jan 01, 2018
Page Range: 156 – 161

Achieving profound pulpal anesthesia in permanent teeth diagnosed with irreversible pulpitis has always been problematic, with the limited success ranging between 60 and 80% with maxillary infiltration 1 , 2 to between 13 and 65% with inferior alveolar nerve block. 3 – 6 Researchers have been continuously searching for adjunctive therapies, such as supplementary injection, preemptive analgesia, and sedation, to improve the success of perceived pulpal anesthesia in these teeth. Ibuprofen, a nonsteroidal anti-inflammatory drug, has

Daniel E. Becker
Figure 4
Figure 4

NSAID versus opioid analgesia. The following data were derived from patients who underwent third molar impaction surgery. See text for explanation.

(Ibu 400  =  ibuprofen 400 mg; Oxy 5  =  oxycodone 5 mg)


Fábio Wildson Gurgel Costa,
 Diego Felipe Silveira Esses,
 Paulo Goberlânio de Barros Silva,
 Francisco Samuel Rodrigues Carvalho,
 Carlos Diego Lopes Sá,
 Assis Filipe Medeiros Albuquerque,
 Tácio Pinheiro Bezerra,
 Thyciana Rodrigues Ribeiro,
 Cristiane Sá Roriz Fonteles, and
 Eduardo Costa Studart Soares
Figure 2.
Figure 2.

Response to use of nonsteroidal analgesics. *Ibuprofen and celecoxib, respectively, were considered analgesics separately. †There was no information available about the choice of patient by better response to NSAID or placebo used. Data represent the number of patients who did not make use of supplementary rescue analgesia.


Daniel E. Becker
Figure 2
Figure 2

Analgesic efficacy. This graph illustrates a typical dose-response curve for orally administered (PO) analgesics. The dose-response curve for opioids such as morphine demonstrates unlimited efficacy in which greater doses provide greater analgesia. At equipotent doses, all opioids demonstrate a similar dose response. In contrast, nonopioids demonstrate a “ceiling” effect that generally is adequate for relief of mild to moderate pain (pain relief rating of 4–5 in this scale). For ibuprofen, doses greater than 400 mg do not provide further analgesia. For aspirin (ASA) and acetaminophen (APAP), this ceiling effect is achieved at 1000 mg and is somewhat lower than that provided by nonsteroidal anti-inflammatory drugs (NSAIDs).


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